What is the Enhancing Oncology Model (EOM)?
The Oncology Care Model (OCM) is dead. The Oncology Care Model was a voluntary, alternative payment model (APM), that “included financial and performance accountability for […]
Medicaid/Medicare
Findings from 2022 Medicare and Social Security Trustees Report
Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds came out with their annual report on the state […]
How to map HCPCS codes to meaningful procedure categories
In order for health care providers to be reimbursed for the services they provide, they need to input a variety of information into health insurance […]
Preferred Pharmacies in Medicare Part D
Medicare Part D plans have begun using preferred pharmacy networks in order to steer their beneficiaries to lower cost pharmacies. A key question is, does […]
Medicare Advantage 2022 enrollment on the rise
Fierce Healthcare reports that in 2022 Medicare Advantage enrollment is continuing to grow at the expense of traditional fee-for-service Medicare. They write that: Medicare Advantage […]
On behavioral change, health and age
A Health Affairs article (Meyer 2021) discusses the potential benefits of Medicare Diabetes Prevention Programs (MDPP). MDPP aims to reduce patient weight and prevent patients […]
CMMI and its revised strategy
Created by Section 3021 of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Innovation (CMMI; aka The CMS Innovation Center) has been […]
GAO Report on MIPS
The Government Accountability Office (GAO) last week published a report evaluating the Merit-based Incentive Payment System (MIPS). MIPS is an approach for CMS to pay […]
Impact of Medicare Pay-for-Performance Program for Surgical Procedures on Cost and Outcomes
In 2008, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital-Acquired Conditions Present on Admission (HAC-POA) program. The goal of this program was […]
Medicare vaccine coverage (including how the COVID-19 vaccines are covered)
How does Medicare cover vaccines? Are the paid for by Medicare Part B or Part D? MedPAC’s June 2021 report provides a nice overview. Medicare […]
Elimination of the Medicaid asset test?
No, this is not coming nation-wide, but it may be on its way in California. Kaiser Health News reports: A provision in California’s newly approved […]
Do most Medicare Part D drugs have CEA studies?
That is the question that a recent study by Tisdale et al. (2021) aim to answer. They first look at the top 250 Medicare Part […]
GAO report on prescription drug advertising
Medicare beneficiaries are largely elderly individuals, many of whom suffer from a variety of health conditions. Pharmaceutical manufacturers want these patients and their physicians to […]
Medicare Advantage vs. Medicare FFS: A Systematic Review
Medicare Advantage has grown over time. In 2020, nearly four in ten (39%) of all Medicare beneficiaries – 24.1 million people out of 62.0 million […]
Impact of COVID-19 on CMS’ value-based programs
Many Medicare payment initiatives aim to link reimbursement to value. Value includes both cost and quality of care. However, measuring quality of care during a […]
Medicare eats the world
In 2020, Medicare premiums and cost sharing were estimated to consume 24 percent of the average Social Security benefit, up from 14 percent in 2000. […]
How much does the U.S. federal government pay for pharmaceuticals?
A number of different federal agencies buy prescription drugs. However, the price at which these pharmaceuticals are purchased varies dramatically. To quantify this variation, a […]
Medicare Part D: Do beneficiaries shop for high-value plans?
Medicare Part D covers prescription drugs for largely elderly Americans in the U.S. Those who qualify for both Medicare and Medicaid receive Part D drug […]
Dual Eligibles’ Medicaid Policy Database
Poor, elderly individuals who may qualify for both Medicaid (for being poor) and Medicare (for being elderly, blind, disabled or have ESRD). In these cases, […]
CBO: COVID-19’s impact on the federal budget
Earlier this month, the Congressional Budget Office (CBO) gave an update to its federal budget projections between 2020 and 2030. As expected, things look grim […]
